A combined group and individual approach to outpatient lithium treatment.

The authors describe a clinic they began in 1980 for patients who take lithium carbonate for the prophylaxis of recurrent psychiatric disorders. They discuss in detail what they have found to be the advantages of this approach. They recommend that other outpatient psychiatric facilities consider a similar program.

CT scanning and schizophrenia: a review.

Methods currently used to quantify CT scans are reviewed, and the benefits and limitations of linear and area measurements are compared. The evidence suggesting that a subgroup of schizophrenics has significantly larger ventricles than normal is examined, with the conclusion that, while not diagnostically useful, ventricular enlargement is of use for theories of pathogenesis. Sulcal enlargement, brain density changes and cerebral asymmetry are also considered.

Hemispheric asymmetries and schizophrenia.

Investigators have hypothesized that schizophrenic patients have abnormal left hemisphere function or deviations from normal function asymmetry. It has also been suggested that schizophrenic patients have reversal of normal structural asymmetries. The authors measured frontal and occipital petalia and frontal and occipital width of each hemisphere on the CT scans of 43 right-handed schizophrenic patients and 40 right-handed control subjects. There were no significant differences in structural asymmetry between the groups. The 8 left-handed schizophrenic patients may have had abnormal functional asymmetries; their mean ventricular-brain ratio, a possible indirect indicator of cerebral atrophy, was higher than that of the right-handed patients.

Ventricular enlargement in schizophrenia: definition and prevalence.

Ventricular enlargement in schizophrenia as measured by ventricular-brain ratio (VBR) has been described by three different research groups. Because of the possibility that the samples might not be representative of the broad population of schizophrenic patients, questions have been raised about generalizability. The authors report on ventricular enlargement in a rigorously defined but representative sample of schizophrenic patients intermittently hospitalized but living in the community. They provide additional evidence that ventricular enlargement does occur in schizophrenic patients, although not at rates as high as those previously reported. Issues related to the definition of ventricular enlargement, as well as the effects of sampling and choice of a control group, are discussed.

Ventricular enlargement in schizophrenia: relationship to positive and negative symptoms.

The authors explored the clinical correlates of ventricular enlargement in schizophrenia by comparing 16 patients with "large" ventricles (ventricles more than I SD above the control mean) with 16 patients with the smallest ventricles from a sample of 52 schizophrenic patients. Patients with ventricular enlargement showed some impairment in the sensorium and had a preponderance of "negative" symptoms (e.g., alogia, affective flattening, avolition, anhedonia), while those with small ventricles were characterized by "positive" symptoms (e.g., delusions, hallucinations, positive formal thought disorder, bizarre behavior). These findings suggest that combining a measure of brain structure with the clinical picture may provide a useful new approach to the classification of schizophrenia.